Iowa ownership and disclosure form 2025

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The document outlines the Iowa Medicaid Ownership and Control Disclosure requirements for providers applying for Medicaid. It mandates the disclosure of ownership interests, management details, relationships among owners, and any adverse actions related to criminal conduct or licensing. Providers must accurately report this information to comply with federal regulations and ensure transparency in ownership and control structures.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How to become an Iowa Medicaid provider?

Providers wanting to enroll as an Iowa Medicaid provider must submit an enrollment application to Iowa Medicaid Provider Enrollment Unit. No payment will be made to a provider for services prior to the effective date of the departments approval of an application.

What is a beneficial ownership disclosure form?

PURPOSE OF DOCUMENT The register to be kept is for the applicable companies and close corporations to submit any beneficial ownership information relating to that entity. Anyone with more than 5% beneficial ownership of a company or close corporation must submit (file) with the CIPC, the requisite information.

What is the disclosure of ownership form?

It helps ensure providers have not been unfairly barred from providing services under any federal health care program. It also helps ensure that Medicaid providers do not have relationships with individuals or entities that have been excluded or terminated from participating in any federal health care program.

What document shows the ownership percentage of a corporation?

Agent means any person who has been delegated the authority to obligate or act on behalf of a provider. Disclosing entity means a Medicaid provider (other than an individual practitioner or a group of practitioners), or a fiscal agent.

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